Get Tehdi Follow-up And Intervention Form - Texas Department Of State ... - Dshs State Tx

Filling out the Tehdi Follow-up And Intervention Form is a crucial step in the process of reporting and managing follow-up care for young children with hearing issues. This guide will provide you with clear instructions on how to complete the form effectively online.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to access the Tehdi Follow-up And Intervention Form and open it for editing.
2. In the 'Today's Date' section, enter the current date when you are completing the form. Then, specify the 'Date of Service' for when the evaluation or intervention took place.
3. Fill in the 'Name of Person Completing Form' field with your name, followed by your 'Phone Number'. Include the 'Office/Practice/Facility Name' along with the city where the service was provided.
4. Provide your 'Email Address', which may be used for communication regarding the case.
5. Proceed to complete the 'Child’s/Patient’s Information'. Enter the child's name, date of birth, name and city of the birth hospital, child’s Medicaid number, mother’s name (including maiden name if available), and mother's Medicaid number.
6. Fill in the caregiver's details, including their name, address, phone number, and the primary care physician's information.
7. Indicate the results from the screening or diagnostic evaluation for both the left and right ears in the respective sections. Ensure to denote whether the tests were done, and the outcomes accordingly.
8. Complete the 'Diagnosis' section by checking all applicable assessment types, including any additional notes on other diagnoses or findings.
9. If referrals to specialty providers are necessary, check off the relevant boxes and fill in the details of the provider and appointment dates for the required services.
10. Make any final recommendations or notes in the 'Recommendations' and 'Notes' sections to provide further context for the case.
11. Once complete, review all entered information for accuracy. After verification, you can save changes, download, print, or share the filled-out form as required.

Complete the Tehdi Follow-up And Intervention Form online to ensure timely management of follow-up care.